Maybe you already know, that filing a health insurance claim is much different from buying insurance products. do not you believe it? Just try posting on social media with a topic “Finding the best health insurance”. not more than an hour, your post was already covered by insurance agents from various companies.
one thing to keep in mind is the health insurance claim is not difficult, as long as it is in accordance with the policy. Therefore, you must be a wise consumer, always look at what you sign.
One of the most important points you should understand from your health insurance policy is the method of claim. The claimed method is generally divided into two types of health insurance:
The two methods have their own deficiencies and advantages. Even so the purpose of the two methods are equally to delegate your medical bills to your insurance company.
The cashless method is a method where you do not need to spend money to make insurance claims. How? than you are confused, let’s look at an example that has made insurance claims with the cashless method.
Steven, 25, had a motorcycle accident that caused his hand to break at night. So that night, Steven went to a hospital that has a program of cooperation with insurance providers.
With cashless insurance, Steven just needs to register by completing the data themselves and swipe the insurance card on the machine provided. After that, Steven can breathe a sigh of relief for not having to worry about spending a lot of money for his treatment.
Easy is not it? but, there are some things you need to understand before you can make an insurance claim like Steven did. We discuss each of the disadvantages and advantages.
(+) No Need to Spend Money
The cashless method eliminates the need for policyholders to have the necessary cash in this kind of health emergency. because the claims are made directly, then the hospital bill is already covered by insurance from the beginning.
(+) Quickly Handled
If you enter a hospital that already has a program of cooperation with insurance providers, you can go directly without having to bother to complete various forms. Just complete the data yourself, swipe the insurance card, and immediately strolled in.
But although it sounds like the easiest method, cashless also has its drawbacks.
(-) Choice of Restricted Hospital
If you read carefully the above cashless profits, you will immediately realize the shortcomings. Yes, not all hospitals provide cashless insurance claims facilities. And not all that provides cashless insurance provider has a program of cooperation with the hospital that you will occupy.
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Reimbursement is a method that existed long before the cashless system was introduced. With this traditional method, you still have to cover all your hospital bills yourself. Later, you just make a claim to your insurance provider by including all bill payment receipts.
For example, at this time steven must go to a hospital that does not provide cashless features. That way, automatically Steven had to have some emergency money he could use for a situation like this. He goes in and out like a typical patient. This means he has to pay the hospital bills from his own pocket first.
Later, Steven will contact his insurance provider to file a claim by including all the billing receipts he paid for at the hospital. If accepted by the insurance, then all the money Steven will be replaced.
It seems not a difficult choice when compared with cashless so easy. However, the reimbursement method has its own advantages and disadvantages as well.
(+) Unlimited At Certain Hospitals
Since the focus of the reimbursement method is the replacement of patient money already paid to the hospital, this method is not limited to a particular hospital. Steven was able to get medical treatment wherever he could show up on his hospital bill.
(-) Must Provide Emergency Costs
Unlike the cashless method, reimbursement depends on the patient’s ability to pay all of his hospital bills first. Automatic must have a reserve of money that will be used to pay. Without the money, the insurance holder will be able to get to the insurance claim stage because it is stuck on a bill that can not be paid.
(-) Longer Process
If the cashless bill method is borne by the insurance without a long process, then the reimbursement is the opposite. Because at the outset already paid by the patient, it is necessary to include very complete information about the chronology and the bills already paid.
Then the claim will be checked thoroughly by the insurance before it is approved to be replaced. It is possible that insurance claims fail to be approved if the insurer finds clumsiness in the claim.
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Whether with cashless or reimbursement, there is one thing you can do to smooth the claim process. Reporting claims made as soon as possible after the event will certainly facilitate the process because the evidence required by the insurance was still ‘fresh’.
And do not forget, whatever method you use, adjust with the insurance policy. Do not make a claim that is more than what is covered in your insurance policy.
If the insurance is covered only the cost of hospitalization, do not ask for the cost of medicines replaced. Later it will be difficult and eventually the claim will not be accepted.
Whatever method you use, your priority is your health. Choose hospitals and services that provide the best care and fit your needs.